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Full text of "Report of the Health Department of the Panama Canal for the calendar year"

REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1933 



Gift of the F^ Canal Museum 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 
MOUNT HOPE, C.Z. 

1934 



REPORT 

OF THE 



Health Department 



OF 



The Panama Canal 

FOR THE 

CALENDAR YEAR 
1933 




J. F. SILER 

Colonel, Medical Corps, United States Army 
CHIEF HEALTH OFFICER 



BALBOA HEIGHTS, CANAL ZONE 



THE PANAMA CANAL PRESS 
MOUNT HOPE, C.Z. 

1934 




For copies of this publication address The Panama Canal. Washington, D.C., or Balboa 
Heights, Canal Zone. 



CONTENTS 

Page 

Title 1 

Organization and activities 5 

Personnel 5 

Financial statements 6 

Patient days in hospital and asylum (see also table 9, page 83) 8 

Vital statistics, populations of the Canal Zone, Panama City, and Colon 10 

General death rates from all causes and from disease only 10 

Canal Zone 11 

Panama City 11 

Colon 12 

Birth rates 12 

Canal Zone 12 

Panama City 13 

Colon 13 

Infant mortality rates 13 

Principal causes of death 14 

Acute transmissible diseases reported 15 

Vital statistics, Panama Canal employees 16 

Death rates 16 

Admission rates to hospitals and quarters 16 

Principal causes of admission to hospital 17 

Noneffective rates, all causes 17 

Admission rates, malaria 17 

Deaths from malaria 21 

Division of Hospitals, Dispensaries, and Charities 21 

Gorgas Hospital 22 

Board of Health Laboratory 23 

Colon Hospital 26 

Corozal Hospital 28 

Palo Seco Leper Colony 31 

Division of Sanitation 32 

Health Officer, Panama City ._-' 34 

Health Officer, Cristobal-Colon 37 

Division of Quarantine 39 

District Nurse for the Pacific side v 40 

General Tables: 

1. Discharges from hospitals, deaths, and noneffective rates for em- 

ployees 43 

2. Causes of deaths of employees arranged with reference to color, 

age, and length of residence on Isthmus 44 



CONTENTS— Continued 

General Tables — Continued: Page 

3. Deaths and death rates of residents of the Canal Zone and the 

cities of Panama and Colon 46 

4. Deaths of residents of the Canal Zone and the cities of Panama 

and Colon, by cause, sex, color, and age 48 

5. Deaths of residents of the Canal Zone and the cities of Panama 

and Colon, by place of residence; absolute numbers and 
annual rates per 1 ,000 54 

6. Statistics regarding American employees and their families 60 

7. Discharges and deaths in hospitals of The Panama Canal, abso- 

lute numbers 62 

7-A. Discharges and deaths in hospitals of The Panama Canal, rates - 

per 1 ,000 population 72 

8. Consolidated hospital and colony report 82 

9. Number of days hospital treatment furnished, and average num- 

ber in hospital each day of the various classes of patients 83 

10. Consolidated admission report, hospitals and dispensaries 83 

1 1 . Report of dispensaries 84 

12. Average number of days in hospitals and quarters for each ad- 

mission, employees only 84 



REPORT FOR THE CALENDAR YEAR 1933 

ORGANIZATION AND ACTIVITIES 

The Health Department constitutes one of the five major adminis- 
trative units of The Panama Canal organization functioning directly 
under the Governor, and its organization and activities were some- 
what comprehensively outlined in the annual report of the Health 
Department for 1930. 

PERSONNEL 

'The only change in personnel assigned to important key positions 
was that of Chief Quarantine Officer, Surgeon Charles V. Akin, United 
States Public Health Service, having been designated as Chief Quaran- 
tine Officer, The Panama Canal, on October 14, 1933, vice Surgeon 
M. Flint Haralson, United States Public Health Service, relieved on 
account of termination of tour of duty with The Panama Canal. 

Total personnel in the service of the Health Department on Decem- 
ber 31, 1933, was 1,025, a reduction of 22 in the white American (gold) 
personnel, and 79 in the colored alien (silver) personnel, under the 
previous year; total reduction 101. The principal reduction in per* 
sonnel (70) occurred at Corozal Hospital for the Insane, and was 
occasioned by the fact that in July 1933, 592 patients, the respon- 
sibility of the Government of Panama, were transferred to the 
Panamanian Government asylum for the insane. The remaining re- 
duction in force, 31 in number, was distributed generally among other 
Health Department units and resulted from necessary curtailment 
in operating expenses to balance the budget. 



Total personnel in the employ of the Health Department, by units, 
for each of the five years 1929 to 1933 inclusive, has been as is indi- 
cated in the following table : 

FORCE REPORT, HEALTH DEPARTMENT, FOR DECEMBER, EACH YEAR 





1929 


1930 


1931 


1932 


1933 




































































































































O 


d 


H 


O 


to 


H 


O 


02 


H 


O 


ad 


E- 


O 


ai 


H 


Chief Health Office 


7 




7 


7 




7 


7 




7 


6 




6 


5 




5 




176 
25 
19 


299 
52 
144 


475 

77 
163 


167 
29 
22 


267 
54 
141 


434 
83 
163 


169 
32 
21 


243 
55 

138 


412 

87 
159 


162 
32 
21 


252 
55 
139 


414 

87 
160 


157 
29 
11 


249 
54 
79 


406 




83 


Corozal Hospital ' 


90 


Line dispensaries 


18 


9 


27 


16 


15 


31 


17 


15 


32 


16 


17 


33 


18 


17 


35 


Palo Seco Leper Colony. . 


2 


36 


38 


1 


28 


29 


1 


28 


29 


1 


28 


29 


1 


28 


29 


Quarantine service 


10 


2H 


33 


11 


20 


31 


12 


20 


32 


12 


19 


31 


9 


18 


27 


Health Office, Panama .... 


11 


128 


139 


11 


118 


129 


11 


118 


129 


11 


105 


116 


8 


106 


114 


Health Office, Colon 


9 


88 


97 


9 


87 


96 


8 


89 


97 


8 


95 


103 


8 


89 


97 




5 


112 


117 


6 


117 


123 


6 


120 


126 


6 


141 


147 


7 


132 


139 






Total 


282 


891 


1,173 


279 


847 


1,126 


284 


826 


1,110 


275 


851 


1,126 


253 


7721.025 









Note. — "Gold" are white American employees, with the exception of two white aliens and one colored alien. 

"Silver" are alien employees, principally West Indians (colored). 
■ Includes inmates paid for services rendered. 

The distribution of the gold personnel (white Americans except 3) 
on the basis of professional and other special qualifications, was as 
follows : 



33 physicians, medical officers of 
. the U.S. Army 
1 physician, surgeon of the U.S. 
Public Health Service 
27 physicians, civilian 

1 dentist, U.S. Army 

3 senior internes 

7 junior internes 

4 male nurses 
95 female nurses 

2 district nurses 
26 clerks 

12 sanitary inspectors 
1 sanitary assistant 
1 quarantine inspector 
4 veterinarians 

8 technicians 

FINANCIAL 



8 dispensary assistants 
5 pharmacists and assistant phar- 
macists 
2 chemists 
2 general mechanics 
2 stewards and stewardesses 
2 dietists 
1 storekeeper 
1 dental hygienist 
1 carpenter foreman 
1 chauffeur foreman 
1 physio-therapy aide 
1 electrician 
1 embalmer 



STATEMENTS 



Operating expenses for the Health Department as a whole were 
$159,286 less than for 1932 ; and comparable earnings were $93,326 less. 
Operating expenses and earnings by units are set forth in the following 
table : 



Operating Expenses and Earnings of the Health Department, 
Calendar Year 1933 



Chief Health Office 

Gorgas Hospital 

Colon Hospital 

Corozal Hospital 

Palo Seco Leper Colony 

Line dispensaries 

Medical store 

Quarantine service 

Sanitation of Panama City and Colon 

Street cleaning and garbage collection and 

disposal, Panama City and Colon. 
Canal Zone sanitation ^ 



Total ^1,542,933.29 



Operating expenses 



'$29,065.09 

^703,920.95 

M50,595.56 

-"126,737. 28 

37,624.01 

97,522.63 

6,629.56 

5 68,149.64 

57,346.73 

132,716.75 

132,625.09 



Earnings 



$328,555.38 

83,762.33 

105,754.80 

24,666.75 

36,790.17 



17,881.46 

9,799.76 

117,581.79 

49,769.02 



774,561.46 



47% 
56% 
83% 
66% 
38% 



26% 
17% 
89% 

38% 



50^ 



' Includes Army pay of Chief Health Officer, which amounted to. $6,120.00 

' Includes Army pay of Army medical officers on duty in this institution, which amounted to 101 ,680.36 

Also includes cost of operation of Board of Health Laboratory. 

3 Includes Army pay of Army medical officers on duty in this institution, which amounted to 28,290.75 

Also includes cost of operating Colon dispensary. 

■< Includes Army pay of Army medical officers on duty in this institution, which amounted to 11 ,425 .41 

Total Army pay of Army medical officers on duty in the Health Department 147,516.52 

5 Includes Public Health Service pay of Public Health Service officers acting as Chief Quarantine Officer . . 5 , 078 . 45 

' Includes Army and Public Health Service pay, which amounted to 152,594 .97 

Operating Expenses of the Health Department, Calendar Year 1933, 
Showing Amounts Charged to Various Accounts 



Gold pay roll (white employees) : 

Panama Canal pay 

Army pay 

Public Health Service pay 

Silver pay roll (colored employees) . 

Subsistence supplies 

Ice 



$567,975.61 

147,516.52 

5,078.45 



Hospital supplies and drugs 

Equipment 

Miscellaneous supplies 

Laundry 

Telephones 

Repatriation of patients physically or mentally disabled 

Medical storehouse operation 

Marine Division, launch and bus service for boarding parties. 

Electric current 

Electric repairs and installations 

Wat er 



Freight 

Mechanical Division, repairs and miscellaneous work. 



$720,570.58 

372,165.57 

166,411.35 

4,555.90 

71,329.41 

18,908.75 

32,360.91 

26,404.66 

15,037.41 

955.49 

6,629.56 

6,173.62 

16,307.18 

4,349.74 

9,994.00 

13,751.15 

3,813.57 



Motor transportation charges (except for hospitals, quarantine 
station, and dispensaries which operate . their own motor 

vehicles) 

Repairs to motor vehicles of hospitals, dispensaries, and quarantiae 

station 

Rental of quarters 

Construction Quartermaster, building repairs 

Municipal Engineering Division, work 

Sale of buildings and surplus equipment, Corozal Hospital 

Miscellaneous expenses 

Total expenses 



$47,325.43 

2,182.84 
555.82 
2,400.70 
2,852.70 
(6,446.12) 
4,343.07 

1,542,933.29 



The extent to which the various units of the Health Department 
have been self-supporting each year for the past 10 years is shown in 
the following table: 





Percent self-supporting 
(Army pay included) 

Calendar years — 




1924 


1925 


1926 


1927 


1928 


1929 


1930 


1931 


1932 


1933 




52 
41 
SI 
40 
27 
38 
17 

58 
39 

48 


53 
39 

82 
45 
34 
46 
20 

60 
37 
50 


51 
37 
80 
38 
35 
53 
18 

61 
29 

49 


57 
44 
85 
46 
32 
35 
11 

81 
29 
53 


54 
44 
76 
41 
34 
38 
13 

82 
29 
51 


52 
52 

88 
46 
35 
49 
16 

82' 

37 

54 


49 
59 
86 
55 
32 
35 
12 

81 
36 
52 


46 
52 
89 
44 
3-1 
32 
15 

82 
33 
49 


47 
51 
94 
65 
43 
24 
14 

82 
35 
51 


47 




56 




83 


Palo Seco Leper Colony 


66 




38 




26 




17 


Street cleaning and garbage collection and 

removal, Panama City and Colon . . . . _ 

Zone sanitation 


89 
38 
50 







PATIENT DAYS SPENT IN PANAMA CANAL HOSPITALS 

NUMBER OF PATIENT DAYS IN HOSPITALS AND ASYLUMS 





1929 


1930 


1931 


1932 


1933 




184,506 

209,794 

27,623 
30,755 
36,568 


163,975 

228,862 

28,923 
41,158 
36,102 


165,050 

228,327 

29,883 
41,508 
34,947 


149,812 

253,240 

31,802 
35,379 
38,543 


149,292 


Corozal Hospital: 


172,413 


Cripples and chronic medical and surgi- 


33.696 




31,378 


Palo Seco Leper Colony 


34,422 






Total , 


489,246 


499,020 


499.715 


508,776 


421.201 







The number of patient days spent in all Panama Canal hospitals 
was 421,201, representing a decline of 87,575 under the previous year. 
The transfer in July 1933, of Panamanian insane to the Panamanian 
Government asylum accounts for 80,827 patient days of this reduction, 
the net reduction in patient days under the previous year being 6,748. 
The average strength of force in the employ of The Panama Canal in 
1933 was only 277 less than in 1932, and the number of employee 
patierit days was 1,460 less (1932, 47,077; 1933, 45,617). There was 
a decrease of about 14,500 patient days in the group of patients drawn 



from families of U.S. Government employees, government contractors, 
private patients, and others entitled to treatment. The number of 
patient days chargeable to charity increased by about 5,300 (1932, 
66,028; 1933, 71,379). During the past few years the military gar- 
risons in the Canal Zone have increased materially (1928, 8,380; 1933, 
9,817), and proportionately the number of patient days spent by 
military personnel in Panama Canal hospitals has been much greater 
(1929, 32,814; 1932, 50,674; 1933, 59,946)— about 10,000 more 
patient days in 1933 than in 1932. The net decline in patient days 
(6,748) is attributable to economic conditions (reduction in pay of 
employees, and unemployment), reduction in activities of contractors 
engaged in U.S. Government construction projects, and to some ex- 
tent to an agreement made in October 1933, between the President 
of the United States and the President of Panama, which provides 
that hereafter no persons except U.S. Government employees and their 
families will be entitled to treatment in Panama Canal hospitals, 
except in emergency. 

.A.VERAGE COST PER PATIENT PER DAY IN PANAMA CANAL HOSPITALS 





Calendar years 




1929 


1930 


1931 


1932 


1933 


Gorgas Hospital: 

Including total cost of Board of Health laboratory and under- 


5.08 

4.87 


5.40 
5.16 


5.07 

4.83 


5.03 

4.76 


4.71 


Including only the cost of work done for this hospital by the 
Board of Health laboratory and its undertaking service . . 


4.47 


Colon Hospital: 


5.18 
5.55 
4.84 


4.27 
4.55 
3.96 


4.39 
4.65 
4.11 


4.72 
5.04 
4.39 


4.80 


Including cost of Colon dispensary, also including the cost of 
the work done for this hospital by the Board of Health 
laboratory and its undertaking service 

Excluding cost of Colon dispensary, but including the cost of 
the work done for this hospital by the Board of Health 
laboratory and its undertaking service 


5.12 
4.47 


Corozal Hospital: 

Including cost of operation of dairy until December 1930; also 


.90 

.92 


.88 
.90 


.70 
.72 


.65 
.67 


.61 


Same as above, also including cost of the work done for this 
hospital by the Board of Health laboratory and its under- 


.64 






Palo Seco Leper Colony: 

Not including work done by the Board of Health laboratory 


1.25 

1.26 


1.06 
1.07 


1.35 
1.36 


.96 
.97 


1.09 


Including cost of the work done for this institution by the 
Board of Health laboratory and its undertaking service. . . . 


1.10 



Note. — Owing to the multiplicity of functions of the various units of the Health Department, the exact cost per 
patient per day (in-patients) is impossible to determine. At Gorgas Hospital a large number of out-patients are treated 
in the various clinics; also the Board of Health laboratory, including the undertaking establishment (which does the 
embalming and cremating, and handles the shipment of bodies, for all units of the Health Department) is operated as a 
part of the hospital ; the Board of Health laboratory does work for various divisions of the Health Department and for 
other departments of the Canal and for the Army. At Colon Hospital the dispensary is manned by hospital personnel 
and it is operated as a part of the hospital ; they have no undertaker, but furnish coffins and hearse ser\'ice for the re- 
mains of colored patients dying therein. 

In the foregoing table no effort is made to exclude the cost of any of the miscellaneous work of the hospitals from the 
cost of caring for in-patients, except that in the second figure shown of per-patient per-day cost for each institution an 
effort has been made to include the proper percentage of expense of the Board of Health laboratory and its undertaking 
service chargeable to such institution; also the cost of Colon dispensary has been deducted in the third figure of cost 
per-patient per-day for that institution, in order to make it more nearly comparable with Gorgas Hospital.' The pro- 
portion of the expense of the Board of Health laboratory chargeable to each institution was arrived at by a check of 
the work ef the ialwratory over a short period of time; on account of variation of the work it is more or less arbitrary. 



10 

VITAL STATISTICS 

POPULATIONS OF THE CANAL ZONE, PANAMA CITY, 

AND COLON 

The Health Department of The Panama Canal secures, analyzes, 
and makes reports on the vital statistics (births, deaths, and disease 
rates) of three geographical units of the population residing on the 
Isthmus of Panama, namely, the population of the Canal Zone, of the 
city of Panama, and of the city of Colon. 

Properly to interpret these statistics, it is essential that there be some 
understanding of the composition of the various units of the popula- 
tion, their movement, and some of the special local factors involved 
which usually are not encountered in stabilized populations in many 
parts of the world. These special factors were discussed somewhat in 
detail in the annual report of the Health Department for 1930 (pages 
12 to 15, inclusive) which can be obtained on request to the Chief 
Health Officer, Balboa Heights, Canal Zone. 

The Republic of Panama takes a census every 10 years, the last 
enumeration having been made in 1930. In Panama City, from 1920 
to 1930, the population made an average increase per year of almost 
exactly 1,500, and that figure has been used as the factor in computing 
the population each year since 1920 by arithmetical progression. For 
1933 the population is estimated to be 79,000 (arithmetical progression). 

In Colon, from 1920 to 1930, the census figures indicate an average 
decrease of 150 per year, and that figure has been used as the factor 
in computing the population between 1920 and 1930 by arithmetical 
progression. As there is some doubt as to the accuracy of the 1930 
census of Colon, 30,000 was adopted for 1931, and continued since. 

The population of the Canal Zone consists of white American em- 
ployees and their families, colored alien employees and their families, 
military and naval garrisons, representatives of shipping companies, 
contractors, church and welfare workers, etc., and colored alien agri- 
culturists who rent land under revocable licenses. A census of the 
Canal Zone population is taken each year and all figures for this group 
are actual rather than estimated. 

The term "employees" as used in HeaWi Department reports in- 
cludes employees of The Panama Canal pi^er and the Panama Rail- 
road Company, which is a corporation owned by the United States 
Government. 

GENERAL DEATH RATES, ALL CAUSES, AND DISEASE ONLY 

Death rates from all causes for all groups of the population have 
been analyzed since the beginning of construction (1905) and those 



11 



from disease only have been tabulated since 1913. Statistical tables 
covering these data are incorporated in the annual report for 1931. 

In this report (1933) the vital statistics incorporated will be limited, 
as was done in the annual report for 1932, to a presentation and brief 
discussion of death rates for the current year and a tabulation of rates 
by consecutive 5-year periods to indicate general trend. 

Health conditions for all groups (Canal Zone, Panama City, and 
Colon) of the population were good; there were no epidemics; malaria 
prevailed to a somewhat greater extent than is usual ; morbidity and 
mortality rates continued their downward trend and in some respects 
declined to an all-time low point. 

Canal Zone. — The death rate from all causes in the calendar year 
1933 was 7.12 per 1,000 of population, the lowest of record (population 
42,851, deaths 305). Deaths from disease only totaled 271 or a rate 
of 6.32 per 1,000 of population, the lowest rate of record since 1913 
except for the years 1930 and 1931, when comparable rates were 6.13 
and 6.09 respectively. 

The general trend of death rates in this group of the population of 
the Isthmus during the past 20 years, both from all causes and from 
disease only, has been very definitely a downward one as is evidenced 
by the following analysis of rates for the past 20 years by 5-year periods. 

CANAL ZONE DEATH RATES BY 5- YEAR PERIODS 





1914-18 


1919-23 


1924-28 


1929-33 


Total death rates per 1,000 population 


11.79 
9.96 


8.00 
6.98 


8.38 
7.23 


7 35 


Death rates from disease per 1,000 population 


6.35 



Panama City. — During 1933 the death rate from all causes was 
14.95 per 1,000 of population (deaths 1,181, population 79,000), the 
lowest of record (1905 to date). The death rate from disease, 14.30 
per 1,000 of population (deaths 1,130, population 79,000), also was the 
lowest of record. The trend in death rates from all causes and from 
disease only has been continuously attaining lower levels during the 
past 20 years as is clearly evidenced in the following tabulation of these 
rates, by 5-year periods, since 1914: 

PANAMA CITY DEATH RATES BY 5- YEAR PERIODS 





1914-18 


1919-23 


1924-28 


1929-33 


Total death rates per 1 ,000 population 


28.45 
27.45 


20.20 
19.51 


18.12 
17.51 


17.04 


Death rates from disease, per 1,000 population 


16.31 







Colon. — In 1933 the death rate from all causes was 16.27 (deaths 
488, population 30,000) and from disease only, 15.63 (deaths 469, 



12 



population 30,000). These rates are considerably in excess of the 
comparable rates for any year since 1921, except for the years 1929 
and 1930. The population figures for Colon have been held at the 
constant figure of 30,000 since the 1930 census, as that census showed 
no material change in the total population for the 10 years inter- 
vening between 1921 and 1930. 

The trend in death rates in Colon by 5-year periods for the past 20 
years is shown in the following table which indicates that death rates 
have been increasing during the past five years: 

COLON DEATH RATES BY 5-YEAR PERIODS 





1914-18 


1919-23 


1924-28 


1929-33 


Total death rates per 1,000 population 


24.92 
23.75 


16 42 

14.56 


14.48 
13.80 


16.13 
15.29 







BIRTH RATES 

Canal Zone {employees and nonemployees) . — In 1933 the birth rate 
for children born alive in the Canal Zone was 10.78 per 1,000 of popu- 
lation (births 479, population 42,851). There were 17 stillbirths, rate 
0.40 per 1,000 population, which, though slightly higher than for 1932 
(0.31) is less than one-half the rate usually experienced in previous 
years. The birth rate (total) for 1933 (11.18 per 1,000 population) 
was less than for 1932 (11.69). The decline in birth rates for this 
group of the population has been continuous from year to year since 
1924 when it was 21.65. 

The persistent decline in birth rates for both groups of the popu- 
lation — white and colored — can be well appreciated by analyzing these 
rates by 5-year periods for the past 15 years: 

CANAL ZONE BIRTH RATES BY 5-YEAR PERIODS, BY COLOR 





1919-23 


1924-28 


1929-33 




White 


Colored 


White 


Colored 


White 


Colored 


Total birth rate per 1,000 of population 


16.80 

16.31 

.49 


28.95 

27.30 

1.64 


12.75 

12.26 

.41 


22.05 

20.66 

1.39 


9.36 
9.13 

.23 


15.03 


Live birth rate per 1,000 of population 

Stillbirth rate per 1,000 of population 


14.09 
.94 







As has been pointed out in previous annual reports, the low birth 
rate in the white American population is influenced by the fact that the 
unmarried military population amounting at the present time to 
about 10,000 individuals constitutes about one-half of this group. 

The colored population is now a fairly well stabilized one. The 
total rate for this group in 1933 was 13.11 per 1,000 of population. 



13 



The decline in this group also has been persistent and continuous 
since 1924 when it was 26.40. In the near future a considerable 
proportion of the generation of the colored population born in the 
Zone will have reached the age of reproduction, subsequent to which 
time it may be anticipated that birth rates will increase. 

Panama City. — In 1933 there were 2,607 children born in the city 
of Panama, population 79,000 (rate 3)i per 1,000 of population). Of 
the total births, 2,508 (31.75 per 1,000) were born alive and 99 (1.25 
per 1,000) were stillborn. There has been a continuous decline 
in the rates for stillborn since 1930 when it was 1.80 per 1,000. 
Incidentally it may be stated that in 1916 the rate for stillborn was 
3.73. During the past 15 years birth rates have tended to decline 
slightly as is evidenced in the following analysis of these rates by 
5-year periods: 

PANAMA CITY BIRTH RATES BY 5-YEAR PERIODS 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population. 
Stillbirth rate per 1,000 population. . 



1919-23 



37.39 

35.24 

2.15 



1924-28 



34.49 

32.74 

1.75 



1929-33 



34.00 

32.47 

1 53 



Colon. — There were 851 children born in Colon (population 30,000), 
the birth rate being 28.37 per 1,000 of population. Of the total births 
809 were born alive, and 42 were stillborn (rates 26.97 and 1.40 
respectively). The general trend of birth rates in Colon during the 
past 15 years is shown in the following analysis of these rates by 
5-year periods: 

COLON BIRTH RATES BY 5-YEAR PERIODS 



1919-23 



1924-28 



1929-33 



Total birth rate per 1,000 population 
Live birth rate per 1,000 population . 
Stillbirth rate per 1,000 population . . 



30.04 

28.38 
1.66 



25.59 

24.21 

1.38 



29.88 

28.46 

1.42 



INFANT MORTALITY RATES 



Infant mortality (absolute numbers and rates per 1,000 of live 
births) for the three groups of population involved were : 



Live birthg (absolute numbers) 

Deaths of children under one year ofage (absolute numbers) 
Mortality rate per 1,000 of live births 





Canal Zone 




Panama 


White 


Colored 


Total 


174 

6 

34 


288 
29 
101 


462 
35 

76 


2,508 
295 
118 



Colon 



93 
115 



14 



INFANT MORTALITY RATES BY 5- YEAR PERIODS 





5-year period 


Canal Zone 


Panama 


Colon 




White 


Colored 


Average 


1919-1923 


37.64 
52.53 
36.19 


127.20 
118.74 
101.13 


94.86 
96.51 
78.89 


154.82 
133.40 
130.18 


139 53 


1924-1928 


114 SO 


1929-1933 


103 10 







That considerable progress has been made during the past 15 years 
in reducing infant mortaUty rates in all elements of the population 
on the Isthmus is evident from the immediately preceding table. 



PRINCIPAL CAUSES OF DEATH 

The principal causes of death for the past five years, for the three 
groups of population involved, are set forth in the following tables: 

SEVEN PRINCIPAL CAUSES OF DEATH FROM DISEASE, CANAL ZONE POPULATION, 1929-1933 
(absolute numbers and rates per 1,000) 





1929 


1930 


1931 


1932 


1933 




38,825 


39,467 


40,565 


42,070 


42,851 






Disease 


Num- 
ber 


Rate 
per 
1,000 


Num- 
ber 


Rate 
per 
1,000 


Num- 
ber 


Rate 

per 

1,000 


Num- 
ber 


Rate 
per 
1,000 


Num- 
ber 


Rate 
per 
1,000 




27 
16 
34 


.695 
.412 
.876 


30 
15 
20 


.785 
.405 
.507 


23 
15 
19 


.567 
.370 
.468 
.271 


14 

18 
33 


.333 

.428 

.784 


34 
26 
21 
15 
14 
12 
12 


.793 




.607 




.490 




.350 




15 


.386 


22 


.557 


20 
14 
10 


.475 
.333 
.238 


.327 








.280 


Nephritis (acute and chronic) 


23 


.592 


21 


.532 


18 


.444 


.280 







SIX PRINCIPLE CAUSES OF DEATH FROM DISEASE, PANAMA CITY, 1929-1933 
(absolute numbers and rates per 1,000) 



Population 

Disease 

Tuberculosis (various organs) 

Pneumonia (broncho and lobar) 

Diarrhea and enteritis, including colitis. 

Nephritis (acute and chronic) 

Organic diseases of the heart 

Cancer (various organs) 



1929 



73,000 



Num- 
ber 



204 
231 
148 
114 
118 
67 



Rate 
per 
1,000 



2.79 
3.16 
2 03 
1.56 
1.62 
.92 



1930 



74,402 



Num- 
ber 



208 
180 



113 
98 
59 



Rate 

per 

1,000 



2.80 
2.42 
1.32 
1.52 
1.32 
.79 



1931 



76,000 



Num- 
ber 



218 
202 
135 

64 
137 

62 



Rate 
per 
1,000 



2.87 
2.66 
1.78 

.84 
1.80 

.82 



1932 



77,500 



Num- 
ber 



203 
174 
104 
69 
67 
69 



Rate 

per 

1,000 



2.62 
2.25 
1.34 



.89 



1933 



79,000 



Num- 
ber 



204 
148 
140 
82 
67 
62 



Rate 
per 
1,000 



2.58 
1.87 
1 77 
1.04 
.85 
.78 



SIX PRINCIPAL CAUSES OF DEATH FROM DISEASE, COLON, 1929-1933 
(absolute numbers and rates per 1,000) 



Population . 



Disease 



Tuberculosis (various organs) . . . 
Pneumonia (broncho and lobar) . 
Organic diseases of the heart . . . . 

Apoplexy 

Nephritis (acute and chronic) . . . 
Cancer (various organs) 



1929 



29,850 



Num- 
ber 

64 
63 
28 
28 
30 



Rate 
per 
1,000 

2.14 

2 11 

.94 

.94 

1.01 



1930 



29,765 



Num- 
ber 



Rate 
per 
1,000 



2.39 
1.65 
1.08 



1.38 



1931 



30,000 



Num- 
ber 



Rate 
per 
1,000 



3.00 

1 70 

1.07 

.77 

.80 



30,000 



Num- 
ber 



Rate 
per 
1,000 



2.47 
1.53 
1.00 
.90 
1.10 



1933 



30,000 



Num- 
ber 



105 
51 
34 
27 
24 
22 



Rate 
per 
1,000 

3 50 

1 76 

1.47 

.90 

.80 

.73 



15 



Tuberculosis and the pneumonias continue to be leading causes 
of death in all three groups of the population, maintaining first and 
second places in the populations of Panama and Colon and first 
and third places in the Canal Zone population. The death rate from 
tuberculosis in the Canal Zone population is less than one-fifth of 
comparable rates in Panama and Colon; tuberculosis affects the 
colored alien population of the Canal Zone to a far greater extent 
than the white Americans. Deaths from degenerative conditions 
of the arteries (arterio-sclerosis and apoplexy) are continuing to occur 
with great frequency. 



ACUTE TRANSMISSIBLE DISEASES 

In the table appearing below is recorded the types of acute trans- 
missible diseases which prevail in the Canal Zone and the cities of 
Panama and Colon, and the frequency with which they occur in these 
groups of the population (approximately 150,000). 

CONTAGIOUS AND INFECTIOUS DISEASES-CASES AND DEATHS REPORTED TO THE 
CHIEF HEALTH OFFICER DURING THE CALENDAR YEAR 1933 





Residence ' 


Disease 


Panama 


Colon 


Canal Zone 


Outside the ] 
Zone and | Total 
terminal cities 




New 
cases 


Deaths 


New 

cases 


Deaths 


New 

cases 


_, ,, New 
Deaths gages 


Deaths 


New 
cases 


Deaths 


Rabies 














1 
16 
14 
164 

1 

465 

31 


1 

i' 

10 

1 

46 


1 
213 
121 
249 

6 
2,240 

288 

1 

11 

(■) 

6 

6 

5 

1 

(') 

35 


1 




i25 
73 

78 

1 
198 
136 

1 

1 
(■) 

1 


5' 

9 

6' 

4 

1 

"'U8 


24 
12 
6 

1 
33 

72 


1 

2 

2 


48 

22 

1 

3 
1.544 


i' 

5' 






7 


Dysentery, amebic. . . 

Dysentery, bacillary 

(unclassified) 


22 

1 

59 


Measles 


49 


4 


Meningitis, meningo- 


1 


Mumps 


3 


5i 


8 
(') 
2 
1 
4 












34 


(■) 


50 


283 


Poliomyelitis 








5 






Scarlet fever 






1 








1 
(•) 
11 












Tuberculosis 

Typhoid fever 

Paratyphoid fever 


204 
5 


(■) 
6 


105 


(■) 
4 


21 
2 


('■) 
14 


41 

1 


371 
8 


Whoooping cough . . . 
Encephalitis lethar- 


5 




34 




35 

1 




5 

1 




79 
2 




Marifime guarantin- 

able diseases 
Cholera 














1 




1 






7 1 4 




6 


7 


Plague 






























Yellow fever 






















Typhus fever 


2 
















2 























■ As many cases of pneumonia and tuberculosis are not reported unless death occurs, this report shows only the 
number of deaths from these two diseases. 

' In cases where we are able to determine the place of infection fairly accurately, the place of infection instead 
of residence is shown. It is usually impossible to trace source of infection in amebic dysentery, but it is certain that 
very few cases are acquired in the sanitated areas of the Canal Zone and the cities of Panama and Colon. A majority 
of cases of malaria shown for the Canal Zone are believed to have been acquired in unsanitated areas. 



16 



VITAL STATISTICS, PANAMA CANAL EMPLOYEES 

To interpret properly vital statistics relating to this group it is 
essential that one have knowledge of the conditions under which they 
are collected, their completeness, and other governing factors. These 
factors were outlined in the annual reports of the Health Depart- 
ment for 1930-1932 inclusive. 

DEATH RATES, ALL CAUSES 

The death rate for all employees (8.67 per 1,000 employees) was 
quite satisfactory (total deaths, 107; average number of employees for 
the year, 12,344) being the lowest since 1924 (7.23). Ninety-seven 
employees died of disease or at a rate of 7.86 per 1 ,000 employees, which 
represents the lowest rate attained since 1927 (7.82). 

The death rate from disease in the colored employees of The Panama 
Canal was almost double that for white American employees, the 
reasons f6r which have been discussed in the annual reports of the 
Health Department for immediately preceding years. 

Death rates in both white American and colored alien employees 
are gradually increasing, as is manifest in the following analysis of 
such rates by 5-year periods, for the past 20 years: 

DEATH RATES OF EMPLOYEES, DISEASE ONLY, BY 5-YEAR PERIODS 



1914-1918 



White employees . . 
Colored employees. 



4.51 
5.93 



1919-1923 



3.20 
7.36 



1924-1928 



4.94 
8.49 



1929-1933 



5.85 
10.02 



The principal causes of death from disease in 1933 were: Tuber- 
culosis, 15; pneumonia, 10; diseases of arteries, 9; syphilis, 8; cancer, 
8; nephritis, 7; apoplexy, 5. 

ADMISSIONS TO HOSPITALS AND QUARTERS 

The admission rate to hospitals and quarters was 845 per 1,000 
employees. As noted last year, this rate has been increasing each 
year since 1926: 1926, 474; 1927, 502; 1928, 595; 1929, 602; 1930, 603; 
1931, 705; 1932, 725; 1933, 845. This increase is attributable to 
gradual increase in the age of those employed (greater prevalence of 
diseases of the chronic degenerative type). 

The admission rate per 1,000 to hospitals for disease by race (white 
and colored) has been as follows for the past five years: 

ADMISSION RATE TO HOSPITALS PER 1,000 EMPLOYEES, BY RACE (WHITE AND COLORED) 





White 


Colored 


1929 


273 
288 
310 
310 
330 


154 


1930 


180 


1931 


187 


1932 


171 


1933 


175 







17 



PRINCIPAL CAUSES OF ADMISSION OF EMPLOYEES TO HOSPITALS 

The diseases causing the greatest number of admissions of em- 
ployees to hospitals during the past five years are incorporated in the 
following table: 



EMPLOYEES, PRINCIPAL CAUSES OF ADMISSION TO 


HOSPITALS 








1929 


1930 


1931 


1932 


1933 


Disease 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Total 


Rate 
per 
1,000 


Malaria (including the few cases treated 
in quarters) 


337 


21 


410 


26 


276 


19 


177 
79 
97 

124 


14 
6 
8 

10 


328 
157 
146 
120 
99 
68 


26.57 
12 72 


Diseases of pharynx and tonsils 


184 


11 


136 


9 


153 


10 


11 83 




9 72 


Diseases of nasal fossae and annexa 


153 
113 
109 
121 


9 

7 
7 






270 
131 


19 
9 


8 02 








81 

77 


6 
6 


5.51 




106 
130 
150 
113 


7 
8 
10 

7 




Gonococcus infection '. . . . 


106 

114 


7 
8 
















Ankylostomiasis ', 

































NONEFFECTIVE RATES, ALL CAUSES, EMPLOYEES 

The noneffective rate for 1933 was 17.33 per 1,000 employees, the 
highest recorded since 1912 (construction days). 

ADMISSION RATES, MALARIA, EMPLOYEES (HOSPITALS AND QUARTERS) 

As malaria is a most important cause of noneffectiveness in this 
geographical area every effort is made properly to diagnose, treat, 
make record of, and determine the source of infection in all cases 
occurring in employees and other persons residing in the Canal Zone. 
Since 1906 careful records have been kept of the incidence of malaria 
in employees of The Panama Canal and its occurrence in this group 
is shown in the following table : 

Malaria Cases, Employees Only 
Absolute numbers and rates per 1,000 employees 





Average 


Number 


Rate 




.■\verage 


Number 


Rate 


Year 


number 


of 


per 


Year 


number 


of 


per 




employed 


cases 


1,000 




employed 


cases 


1.000 


1906 


26,547 


21,795 


821 


1920 


20,673 


401 


19 


1907 


39,238 


16,637 


424 


1921 


. 14,389 


214 


15 


1908 


43,890 


12,372 


282 


1922 


10,447 


176 


17 


1909 


47,167 


10,169 


215 


1923 


10,976 


212 


19 


1910 


50,802 


9,487 


187 


1924 


11,625 


190 


16 


1911 


48,876 


8,987 


184 


1925 


12,180 


330 


27 


1912 


50,893 


5,623 


110 


1926 


12,732 


179 


14 


1913 


56,654 


4,284 


76 


1927 


13,561 


145 


11 


1914 


44,329 


3,635 


82 


1928 


14,260 


203 


14 


1915 


34,785 


1,781 


51 


1929 


16,193 


337 


21 


1916 


33,176 


547 


16 


1930 


15,524 


410 


26 


1917 


32,589 


473 


14 


1931 


14,597 


276 


19 


1918 


25,520 


472 


18 


1932 


12,621 


177 


14 


1919 


24,204 


752 


31 


1933 


12,344 


328 


27 



MR 39231- 



18 

The rate per 1,000 employees for 1933 was, in round numbers, 27 
(actually 26.57), the highest since 1925 when a rate of 27.09 was at- 
tained. The malaria season for 1930, when a rate of 26.4 per 1,000 
employees was recorded, is comparable in many respects to that of 
1933. 

Many factors, some known and some unknown, influence these rates 
from year to year. The various factors which may possibly influence 
the rate of prevalence of malaria are constantly under observation 
and the results of such observations are recorded in the annual 
reports of the Health Department to which those especially interested 
are referred. Marked annual variations in rates occur notwithstand- 
ing that continuously for many years the permanent drainage projects 
have been improved and extended and that extensive new drainage 
works have been installed. 

The rate for 1933 (27) was in excess of those usually attained since 
1916 (14 to 19 per 1,000) and was attributable to a number of factors 
among which the following may be cited : 

(a) Continuation of large construction projects beyond the limits of the 
so-called "sanitated areas." — Construction projects of this nature were 
engaged in during 1925 (fortifications) and have been under way 
since 1929 (road construction on east and west sides of the Canal, 
Pacific side, and construction of Madden Dam). 

(b) Unusual prolongation of the rainy season. — Ordinarily the rains 
begin to taper ofi^ in late November and by the middle or latter part 
of December the dry season is well under way and small collections of 
water suitable for anopheline breeding have dried up. In .1932 the 
rains continued until the latter part of December, A. albintanus 
breeding places beyond the limits of the sanitated areas were abundant 
until January 1933, and flights of A. albimanus into the sanitated 
areas still were occurring. As a result, the malaria rate for the month 
of January 1933 (annual basis) was 31.3 per 1,000 employees, which 
is much higher than is usual (January 1932, 15.2; 1931, 23.6; 1930, 
20.3; 1929, 22.5; 1928, 6.7). Incidentally, it may be stated that the 
end of the rainy season in 1933 was quite similar to that of 1932, 
and as a result the malaria rates for January 1934 — when this 
report is being written — are unusually high (28.0 per 1,000). 

(c) Dredging Division projects. — In the early part of the dry season 
of 1933, the Dredging Division initiated a project including the con- 
struction of a dyke damming up the Rio Grande and its tributaries on 
the west side of the Canal just north of Balboa, with construction of a 
spillway at the upper end of the dyke. This area is to be used for 
dumping purposes in dredging silt from the Canal. Temporarily and 



19 

to enable the silt to settle solidly, it was necessary to bring the water 
up to a high level. This level could not be lowered until some time 
after the rainy season began and as a result a considerable amount of 
fresh water accumulated in the tributaries emptying into the Rio 
Grande River. The areas were patrolled regularly and as soon as 
breeding was found efforts were made to control it by oiling. It was 
not possible, however, markedly to lower the level of the water until 
about August or September. In the meantime the amount of breeding 
was very greatly curtailed. Temporary drainage works have been 
constructed in this area, the channel leading to the spillway has been 
lowered, and we anticipate no great trouble from it during the next 
rainy season. A second Dredging Division project (fill) on the 
Thatcher Highway in the vicinity of Farfan beach (west side of Canal, 
opposite Fort Amador and La Boca) has not, as yet, settled solidly 
and therefore is not adequately drained. The result was that during 
the latter part of the rainy season A . albimanus bred so abundantly 
as to necessitate dusting with paris green by airplane. The fill, 
which consists of silt from the Canal, is still too soft to permit construc- 
tion of permanent drainage systems. Fortunately, the area in the 
vicinity of the Dredging Division projects has been depopulated and 
there is but little opportunity for malaria-transmitting mosquitoes 
to acquire infection except from individuals from the interior of 
Panama awaiting ferry connections at the ferry slip on the west side 
of the Canal at night. Sometimes the waiting period is a half-hour 
or more. 

(d) Aquatic flora, Gatun Lake. — Observations during the past few 
years indicate that the amount of A . albimanus breeding in Gatun 
Lake is increasing rapidly due to changes in the aquatic flora. This 
problem was discussed in the Annual Report, Health Department, 
Panama Canal, for 1932 (pp. 43-45) and further details are incorpo- 
rated elsewhere in this report. Evidence also in accumulating that 
the dispersal flights of A. albimanus always noted at the beginning 
of the rainy season, before rains are sufficient in volume to possibly 
result in breeding within the sanitated areas, are coming from the 
Gatun Lake area. Anopheles breeding in the lake during April, 
May, and June 1933, was materially greater than usual. Rains in 
sufficient volume to raise the lake level occurred much later than is 
usual and as a result the decline in the water level of the lake during 
the dry season was approximately five and two-thirds feet rather than 
the usual five feet. Consequently materially more extensive areas of 
matted decaying Chara were present on the surface of the lake than 
usually are found in its shallow parts. As these mats afford ideal 



20 

food and shelter for Anopheles breeding, the amount of breeding Avas 
much more extensive than usually is observed. There now appears 
to be no doubt that the dispersal flights of Anopheles observed 
throughout the Isthmus in May and June each year have their origin 
principally in the Gatun Lake region and that the prevailing con- 
ception that A. albimaniis has a short flight range requires revision. 
The flight from the lake to the Atlantic terminal is not less than 
four miles, and to the Pacific about 12 miles or more. 

(e) Overhaul work on Panama Canal locks. — Overhaul of the locks 
on the Pacific side was in progress from January 3 to June 9, 1933, 
during which period several hundred laborers were employed on both 
day and night shifts. Chronic carriers of malaria are common in 
such groups. During the latter stages of this overhaul when Anoph- 
eles flights were coming into the sanitated areas from the dredging 
projects on the west side of the Canal, in close proximity to the Pacific 
locks, and also from the lake area, abundant opportunity was offered 
the malaria transmitting mosquitoes to become infected through 
attacks on labor forces engaged in night work on the locks. During 
the latter part of May and the first part of June the Special Service 
Squadron of the Navy was at anchor in the basin off piers 15 and 16, 
Balboa, and for the first time in a number of years an unusually large 
number of cases of malaria were undoubtedly contracted on board the 
vessels. 

(f) Visits to the provincial districts of Panama. — Until recent years 
but few sections of the provincial districts of the Republic of Panama 
were easily accessible except by coastwise steamers, and opportunities 
for employees and their families to visit these districts were greatly 
restricted. This barrier greatly reduced opportunity to acquire 
malaria. During the past 10 years the Public Works department 
of the Government of Panama has been actively engaged in the 
improvement and extension of existing highways and the construction 
of new ones. The result has been that in increasingly large numbers, 
the American employees of The Panama Canal are making automobile 
trips to the provincial districts, building cottages in various coastal 
areas for week-end and vacation use, and visiting with increasing fre- 
quency interesting localities in the coastal and other areas. Not- 
withstanding that employees are warned as to the possibility of con- 
tracting malaria during visits to nonsanitated areas, and are urged to 
safeguard themselves at night, most of them fail to do so. The 
result is that constantly increasing numbers of American employees 
and their families are contracting malaria through exposure in non- 



21 



sanitated areas. Conditions are such that it may be anticipated that 
the numbers of individuals acquiring malaria from this source will 
continue to increase. 

DEATHS FROM MALARIA, EMPLOYEES 

In 1933 two employees died of malaria, a rate of 0.16 per 1,000 
employees. One of these deaths was that of an American employee 
who contracted a malignant tertian infection at New Gorgona beach, 
a coastal resort in the interior of Panama, had clinical symptoms for 
several days before reporting to a physician, and when seen by a 
Panama Canal physician was in a comatose condition. He was ad- 
mitted to hospital immediately and died within three or four hours 
thereafter. The second fatal case was that of a Panamanian laborer 
employed at Madden Dam but living in one of the nearby nonsani- 
tated native villages in the Republic of Panama. The patient was 
treated for an estivo-autumnal infection in February 1933, readmitted 
to hospital on April 3, 1933, and died of blackwater fever seven days 
later. 

Annual death rates from malaria in employees since 1906 have been 
as is shown in the following table : 

Deaths From Malaria Among Employees Only 
(Absolute numbers and rates per 1,000 employees) 



Year 


Average 

number 

employed 


Number 

of 
deaths 


Rate 
per 
1,000 


Year 


Average 

number 

employed 


Number 

of 
deaths 


Rate 

per 

1,000 


1906 
1907 


26,547 
39,238 
43,890 
47,167 
50,802 
48,876 
50,893 
56,654 
44,329 
34,785 
33,176 
32,589 
25,520 
24,204 


233 
154 

73 

52 

50 

47 

20 

21 

7 

8 

2 

3 

2 

2 


8.78 

3.92 

1.66 

1.10 

.98 

.96 

.39 

.37 

.16 

.23 

.06 

.09 

.08 

.08 


1920 
1921 
1922 
1923 
1924 
1925 
1926 
1927 
1928 
1929 
1930 
1931 
1932 
1933 


20,673 
14,389 
10,447 
10,976 
11,625 
12,180 
12,732 
13,561 
14,260 
16,193 
15,524 
14,597 
12,621 
12,544 


3 


.15 


1908 






1909 






1910 
1911 


2 


.17 


1912 






1913 






1914 






1915 
1916 


1 


.06 


1917 
1918 


1 


.07 


1919 


2 


.16 



DIVISION OF HOSPITALS, DISPENSARIES, AND CHARITIES 

The units comprising this division and the scope of their activities 
were outlined in the annual report for 1930. Brief reports of each of 
these units for 1933 follow: 



22 

GORGAS HOSPITAL 

(Normal capacity, 880 beds) 

Col. Orville G. Brown, Medical Corps, U.S. Army, Superintendent 

In addition to the routine work of maintenance and repair of build- 
ings and equipment by the hospital artisans during the year, the 
following major plant improvements were made: 

1. The refrigerating plant and cold storage rooms of the hospital 
main kitchen were completely overhauled and repaired at a cost of 
$3,350. 

2. A new paint shop was constructed on a site adjacent to the 
present shops building at a cost of $2,150. This activity was formerly 
located under one of the ward buildings and, together with the storage 
of inflammable material, constituted a fire menace which has now 
been removed. 

3. The old, worn-out galvanized iron pipes in Section "B" are being 
replaced with a new system of modern brass piping. The installation 
is now about 75 percent complete. All necessary material for this 
work costing about $1,000 is on hand but, for reasons of economy, the 
work is being accomplished only when the plumber is not otherwise 
engaged. 

4. The interiors of kitchen, mess halls, isolation building and section 
"B" have been repainted throughout. 

5. The parking site in rear of the Administration-Clinics building 
was enlarged at a cost of approximately $900. 

About $6,500 was expended during the year for new equipment and 
replacements of worn-out or obsolete articles, of which about $1,900 
was devoted to new equipment for the hospital subsistence department. 

Cases treated. — There were 11,621 admissions during the year, with 
a total of 149,292 patient days. An average of 12.46 days in hospital 
was spent by each patient under treatment as compared with 13.22 
days per patient during 1932. The average number of beds occupied 
daily during the year was 409.02. 

Surgical service. — There were 2,109 major operations (with 31 
deaths) and 4,096 minor operations (with 2 deaths) performed during 
the year; 440 obstetrical cases were delivered, in which there were 
8 twin births and 14 stillbirths; 9,779 patients received treatment in 
the out-patient service. 

Medical service. — During the year, 6,216 patients were admitted to 
and treated in the medical wards. In addition to the hospital service, 
.8,675 patients were treated in the out-patient service. 

Eye, ear, nose and throat service. — There were 9,691 visits to the out- 
patient department during the year; 1,610 operations were performed 
and 1 ,065 refractions were done. 



23 

Radiographic service. — There were 7,505 cases handled, for which 
18,472 films of various sizes were used, and in which 991 fluoroscopic 
examinations were made. 

Dental service. — There were 5,088 sittings during the year; 1,360 
oral examinations, 1,950 teeth extracted, 265 complete and 991 
partial dental X-ray examinations. 

Physio-therapy service. — Treatments were given as follows: 128 
radium, 2,431 roentgen, 1,481 electro-therapy, 3,750 thermo-therapy, 
3,688 actino-therapy, 4,262 massage and exercise, and 3,240 hydro- 
therapy. 

BOARD OF HEALTH LABORATORY 

(Operated in connection with Gorgas Hospital) 
Dr. L. B. Bates, Chief of Laboratory 

Bacillus typhosus. — Recovered in blood culture from 13 individuals, 
from the urine specimen of one other, and from four other cases at 
autopsy. Six of these lived in Panama City, 3 in Colon, 3 were 
transients, 2 from Madden Dam, 2 from Canal Zone towns, and 2 
from Canal Zone unsanitated areas. 

Typhoid carriers. — On December 31, 1932, there was only one B. 
typhosus carrier, H.B., under sanitary surveillance. His stool speci- 
mens were examined 10 times during the year and found positive 
3 times. One new temporary carrier was found during the year. 
H.B. was the only carrier under sanitary surveillance on December 31, 
1933. 

Chagas' disease {Schizotrypanum cruzi). — The first case of this disease 
to die in the Canal Zone or Republic of Panama, so far as is known, 
was autopsied on August 7, 1933. A brief summary of the case is as 
follows: Autopsy No. 10, 203, F.B., age 3 months, 11 days; male; 
black; residence, land license 1299 B.E., Chiva Chiva trail, Canal 
Zone; place of death, residence as given above; time on Isthmus, life; 
principal findings at autopsy: Schizotrypanum cruzi in myocardium, 
percarditis, otitis media, bronchopneumonia, right lower lobe, fatty 
metamorphosis of liver. 

Snake bite. — The fourth autopsy at this laboratory on an individual 
dying of snake bite was performed on November 2, 1933. P.B., 
colored, laborer, Colombian, age 25 years, was bitten October 28, 1933, 
while obtaining a piece of sugar cane on Arinosa Farm, land license 
765, Cristobal-West. He died November 2, 1933. The snake was 
killed by the victim but it was not recovered for identification. The 
history and autopsy findings were such that there was no doubt as to 
the cause of death. 



24 



Reports. — Approximately 38,900 laboratory examinations were 
made. The volume and character of the work is indicated in the 
following summaries : 

Bacteriological, protozoal, and miscellaneous examinations. — Cul- 
tures of blood, 213; cultures of stools (typhoid-dysentery), 946; cultures 
of urine, 1,266; cultures from nose and throat, 1,576; cultures of sputum, 
58; cultures of spinal fluid, 178; cultures of miscellaneous material 
(eye, pleural fluid, skin lesions, pus, bile, glands, autopsy tissues, 
etc.), 189; darkfield examinations, 81; staining and examination of 
smears (conjunctival, throat, urine, urethral, vaginal, sputum, etc.), 
272; autogenous vaccines, 52; examination of lepers and leper sus- 
pects, 10; examination of urine for tuberculosis, 4; examination of 
spinal fluid for tuberculosis, 153; examination of feces for ova of 
parasites and protozoa, 103; blood films for malaria parasites, 
8,018; bacteriological examinations of water, 743; bacteriological 
examinations of foodstuffs (cultures of milk, cream, ice cream, soft 
drinks, etc.), 756. 

SEROLOGICAL EXAMINATIONS 

Wassermann tests 18,307 

Kahn tests 2,317 



Agglutination tests 

Positive with B. typhosus (Eberthella typhi) .... 

Positive with B. proteus -Y. , ( Proteus vulgaris) . 
Fragility tests. 



Blood typing for traasfusion 

E.xamination of blood for coagulation time. 



210 



Analysis of Wassermann reactions. — There were 17,488 Wassermann 
tests performed on the blood of 13,201 persons. The results are 
summarized below: 

TABLE SHOWING NUMBER OF PERSONS ON WHOM BLOOD WASSERMANN TESTS WERE MADE AT 
BOARD OF HEALTH LABORATORY AND RESULTS OF TESTS, 1933 



Race, sex, and status 


Individuals 
positive 


Individuals 
negative 


Total 

individuals 

tested 


Percent of 

individuals 

positive 


White, civU: 

Males 


74 

29 

3 


1,688 
592 
111 


1,762 
621 
114 


4.2 




4.6 


Children 


2.6 






Total 


106 


2,391 


2,497 


4.2 






White, military and naval: 

Soldiers, continental United States 


119 
21 


3,953 
270 


4,072 
291 


2 9 


Sailors, U.S. Navy 


6.8 






Total 


140 


4,223 


4,363 


3.2 






Black and mulattoes: 

Males 


435 

245 

14 


2,711 

2,646 

230 


3,146 

2,891 

244 


13.8 




8.1 


Children 


5.7 






Total 


649 


5,587 


6,281 


11 






Chinese, males and females 


4 


56 


60 


6.6 






Grand total 


944 


12,257 


13,201 


7.1 








25 

In addition, Wassermann tests were made on 819 spinal fluids taken 
from 612 individuals. The results are summarized below: 

Individuals positive 5S 

Individuals negative 554 

Total individuals tested 612 

Percent of individuals positive 9 ■ 48 

PATHOLOGICAL EXAMINATIONS 

Autopsies. — There were 3'\9 autopsies performed at the Board of 
Health laboratory. The more frequent causes of death were as 
follows : 

Cause of death Cases autopsies 

External causes 

Tuberculosis (acute and chronic) 

Organic heart disease (acute and chronic) 

Pneumonia (broncho and lobar) 

Cancer 

Syphilis (including 4 general paralysis) 

Cerebral hermorrhage 

Bright's disease (acute and chronic nephritis) 

Bodies autopsied. — The annual report for 1930, page 54, contains a 
table showing the number of autopsies performed for the years 1904- 
1930 in certain diseases that but rarely come to autopsy in this area. 
The additions to this table for 1933 were as follows: Yellow fever, 0; 
beriberi, 0; ankylostomiasis, 0; tetanus, 0; infectious diseases of 
children, 1; plague, 0; smallpox, 0. 

Five hundred and two bodies (not including 54 for storage only and 
2 disinterred) passed through the laboratory; 317, or 63.14 percent 
were autopsied. 

There were 27 malaria carriers found at autopsy. 

There were 30 cases of syphilis found at autopsy. 

Three cases autopsied, or 0.94 percent, showed intestinal parasites. 
Ascaris lumbricoides were found in each of the three cases; no search 
for ova made. 

Laboratory examinations of wild and domestic animals. — Cultures 
from guinea pigs, rabbits, etc., 36; autopsies and histological ex- 
aminations of cows, hogs, parrots, guinea pigs, rabbits, etc., 72; 
examinations of rats for plague, 2,855. 

Preparation of tissues for examination (slides), 8,864. 

Chemical analyses and examinations. — Alcohol, 7; beverages, 16; 
analyses of blood (nitrogen, urea, uric acid, creatinin, glucose, calcium, 
carbon dioxide, cholesterol, icterus index, phosphorus, sodium chloride, 
etc., 2,311; analyses of foodstuffs, drugs, and chemicals, 616; gastric 
analyses, 532; spinal fluid, 854; drugs, for identification, 23; toxi- 
cological examinations, 7; quantitative analyses of urine, 205. 



26 

In addition to the more highly technical laboratory work done in 
the Board of Health laboratory, the various sections of Gorgas 
Hospital have laboratories in which routine clinico-pathological work 
is done. The amount and character of work done by these units can 
be judged from the following summaries of their activities: Blood 
films examined for malaria, 13,898; red cell counts, 7,749; white cell 
counts, 9,127; differential counts, 9,030; coagulation time determina- 
tion, 18; Van den Berg tests, 45; sickle'^ells, 51; qualitative analyses, 
urine, 24,406; phenolsulphonephthalein test urine, 66; urethral smears, 
107; vaginal smears, 170; prostatic smears, 315; stools for ova of 
parasites, 10,182; sputum for tuberculosis, 1 ,804 ; cell count spinal fluids, 
274; throat smears, 33; gastric contents for occult blood, 76. 

UNDERTAKING DEPARTMENT 

Bodies received (including 2 disinterred and 54 for storage) 558 

Bodies embalmed 82 

Bodies cremated 104 

Bodies buried on Isthmus 400 

Bodies shipped from Isthmus (including 2 disinterred) 55 

Bodies buried at sea 1 

COLON HOSPITAL 

(Capacity, 135 beds) 

Maj. Dean F. Winn, Medical Corps, LI.S. Army, Superintendent 

This hospital has continued to function essentially as an emergency 
hospital although definitive treatment has been given to a wide range 
of cases. Individuals requiring certain special examinations, for which 
equipment is inadequate, those with venereal and contagious diseases, 
and mental and tuberculosis cases, were transferred to Gorgas Hospital. 

The utilities department has been active in preserving the appear- 
ance of buildings and grounds and the upkeep of the various depart- 
ments. 

New construction. — The new nurses' quarters was completed and 
occupied in April. This is a 2-story reinforced concrete building 
with tiled roof, located just east of the main hospital building and 
facing Limon Bay. It affords commodious quarters for 16 nurses, 
including a suite of two rooms and bath for the chief nurse, and a 
common bath and lavatory for each two rooms. On the second floor 
there is an attractive lounge and on the first floor a reception hall, 
parlor and dining room. The kitchen and pantries are equipped 
but have not yet been used for a separate mess. Bedrooms and 
living rooms have been equipped with new furniture. 

In August the old nurses' quarters was remodeled and occupied 
by the dispensary. The building is detached from the main hospital 
buildings. It houses the gold and maternity- pediatric clinic, the 



27 

silver clinic, laboratory, X-ray rooms, emergency dressing room, and 
pharmacy. In addition, rooms are provided for the officer of the day, 
dispensary office, and for temporary isolation. There are ample and 
convenient suites of offices, waiting rooms and examining rooms for the 
clinics. The laboratory is large and well lighted. The pharmacy 
is well arranged and has adequate storage space. The building is so 
arranged as to segregate completely white and colored patients. 

In August a concrete and wood covered walk was constructed to 
connect the new dispensary with the hospital. This has proven a 
great advantage during the past rainy season. 

In October the lower floor of the west wing of the main hospital 
building was remodeled. This section, formerly occupied by the 
dispensary, laboratory. X-ray department, and eye, ear, nose and 
throat department, has been converted into a ward containing eight 
private rooms and a 6-bed ward. The west end of this section was 
utilized for the construction of a suite of rooms for an eye, ear, nose and 
throat clinic. An operating room for this department was constructed 
by remodeling the existing porte cochere. 

A filing room for storing clinical records, etc., has been equipped 
in the service building with steel shelving with a capacity of some 
45,000 charts. 

The shop and laundry facilities have been enlarged by the con- 
struction of a covered area with concrete floor and a large insulated 
drying room. This room is heated by an ingenious construction of 
the flue leading from the fire box over which emergency laundry is 
boiled. There is no expense for fuel as only waste material, such as 
old packihg boxes, crates, etc. is used. 

Movement of sick. — There were 4,160 admissions during the year with 
a total of 31,378 patient days, the average being 7.5 days per patient. 
Army personnel accounted for 8,305 patient days. There were 53,612 
visits to the dispensary, including eye, ear, nose and throat and 
surgical clinics, a daily average of 147. There were 19,384 white 
patients and 34,228 colored patients. The average number of beds 
occupied daily was 86. 

Surgical service. — There were 481 major operations. Included in 
these there were: Appendectomy, 166; hernia repair, 48; hemorrhoid- 
ectomy, 64; hepatic abscess, 3; intestinal obstruction, 8; perforated 
peptic ulcer, 5; hysterectomy, 17; cesarean section, 6; uterine sus- 
pension, 16; miscellaneous gynecological operations, 79. There were 
510 minor operations; 177 fractures were treated. 

A number of new items of equipment were added. Among these 
were a new electric dressing sterilizer, gas-oxygen anesthesia outfit, 
and electric cautery. 



28 

Obstetrical service. — ^There were 368 deliveries during the year. 
There were 17 sets of twins, 11 forceps deliveries, and 6 cesarean 
sections. An active well-conducted prenatal clinic is maintained. 

Medical service. — The general scope of the work has been satisfactory 
in both volume and variety. No serious epidemics occurred during 
the year. 

Eye, ear, nose and throat service. — This service was established in the 
latter part of 1932. It has grown to be one of the largest and most 
important departments of the hospital and has filled a very definite 
need for the population on the Atlantic side of the Isthmus. During 
1933, 1,176 operations were performed; 9,503 treatments were recorded 
for hospital patients and 5,713 treatments were given out-patients. 
Refractions numbered 698. The following abbreviated statistical 
report of operations is submitted as an indication of the scope of the 
work performed: Mastoidectomy, 8; cataract operations, 20; ptery- 
gium transplant, 94; trephine, 6; enucleation, 5; foreign body (cornea), 
33; plastic of eye, 19; correction of ptosis, 3; correction of squint, 12; 
submucous resection, 139; sinusotomy, 40; radical antrum, 7; radical 
frontal, 11; ethmoidectomy, 10; plastic (nose), 8; plastic (ear), 4; 
cartilage inlay (face), 1; miscellaneous, 756. 

X-ray department. — There were 1,349 examinations made during 
the year. New and modern equipment was installed upon completion 
of the new dispensary building so that this department is now able 
to do a more satisfactory and varied type of work than formerly. 

Laboratory. — Only routine work is done, serological and pathological 
work being performed by the Board of Health laboratory, Ancon, C.Z. 
The laboratory in the new dispensary building is well lighted and 
adequate space for expansion is provided. 

Dispensary. — The Colon dispensary is conducted as a department 
of Colon Hospital. The combined gold and maternity-pediatric 
clinic is under the direction of the district physician who is also in 
general charge of the entire dispensary. Both white and colored 
patients are cared for in this clinic but the hours and waiting and 
examining rooms are so arranged as to segregate the races. The 
silver clinic is conducted by members of the hospital staff assigned 
in rotation. 

COROZAL HOSPITAL 

(Capacity, 550 patients) 

Maj. F. H. Dixon, Medical Corps, U.S. Army, Superintendent 

Purpose. — Until recently this institution served to accomodate the 
insane of the Canal Zone and of the Republic of Panama, the latter 



29 

class of patients being cared for at the expense of the Republic at a 
fixed rate of 75 cents per day. However, during June and July of 
1933, all of the latter class, totaling 592 patients were transferred 
to the Retiro Matias Hernandez, an asylum located on the Sabanas 
road about five miles from Panama City, and erected during recent 
years for this purpose. American or alien employees of the Panama 
Canal, disabled by reason of injuries or chronic diseases, or enfeebled 
by advanced age, who desire to enter the institution, are cared for in 
Corozal Hospital. 

As a result of the exodus of this great number of patients, six of the 
old wooden structures were sold and torn down, and all male and 
female insane patients consolidated in the new 2-story concrete 
building completed in November 1931, while the cripples and chronic 
patients are now quartered in the concrete structure formerly used 
as a ward for insane women patients. To make these buildings 
suitable for this purpose certain alterations were necessary, such as 
removal of sliding doors and screens, constructions of new doorways, 
installation of handrails along stairways, the erection of new walls and 
partitions to separate the male from the female patients, and arranging 
space for dining halls. These changes were all made by hospital 
personnel under the supervision of the general mechanic. The 
concentration of all insane patients in one building promotes efficiency 
and also makes it possible to operate with more limited personnel. 
At the same time, removal of the six wooden structures which were 
no longer needed reduces the cost of maintenance for painting and 
repairs. One building, ward "B," also of wood construction, being of 
more recent origin, was retained to provide for emergencies and will 
accommodate about 160 patients. 

A new cemetery tool shed to replace the old building, which was 
too small for present requirements and in bad state of repair, is being 
erected by hospital labor under the supervision of the general mechanic, 
at an estimated cost of $350. This tool shed is more centrally located 
than the old building, since the cemetery area has been enlarged and 
new roads constructed in the 40-acre plot recently added. Con- 
siderable work remains to be done in connection with the enlargement 
of the cemetery, and it will be necessary to relocate the boundary 
fence, erect additional gates and construct paths through the new 
section. 

Routine painting and repairs to woodwork, steel doors, window 
frames, plumbing, boiler and steam lines, and filling and grading of 
hospital grounds, have been performed by hospital artisans with the 
help of patients. 



30 

Insane patients. — The census on December 31, 1933, was 178, as 
compared with 748 at the end of the previous year. The number 
admitted was 247, as compared with 338 for 1932. There were 782 
discharges and 31 deaths. There were no suicides, but one death 
resulted due to altercation between two patients. 

Other patients. — There were, on December 31, 73 black and 6 white 
chronically ill or crippled inmates (not insane), as compared with 59 
black and 5 white of this class at the beginning of the year. Twenty- 
four were carried on the pay rolls, employed as broom-makers, janitor, 
and laborers. The broom-makers manufactured approximately 260 
brooms per week. 

Recreation. — Because of the reduction in the number of patients and 
the limited personnel, the weekly moving picture shows were dis- 
continued in July 1933. However, band concerts through the courtesy 
of the 11th Engineers Band, Corozal, are provided about every other 
week, unless Army maneuvers or other duties prevent. Refreshments 
in the form of candies, cookies, cigarettes, tobacco, etc., are distributed 
among the chronic and insane patients, the latter receiving this 
distribution in lieu of cash in case they are employed on the patients' 
pay roll. Church services were conducted once a week for the Cath- 
olic and Protestant patients. However, in view of the limited number 
of Catholics remaining since the transfer of patients to Matias Her- 
nandez asylum, such services have been discontinued since July 1933. 

Treatment. — Intensive specific treatment was given to patients 
suffering from syphilitic psychoses. Three hundred and seventy- 
three doses of arsphenamin were administered intravenously, and 219 
lumbar punctures were made. At the end of the year there were 29 
patients suffering from neuro-syphilis in some form; 25 of these were 
males and 4 females. 

Occupational therapy. — Because of the transfer of approximately 
77 percent of our insane patients, the very limited number of remaining 
patients and the need for economy, the occupational ward was dis- 
continued and the services of the female nurse formerly in charge 
dispensed with. 

In addition to the male patients engaged in the occupational ward 
there were others employed in agricultural activities. The value of 
the produce taken from the patients' garden for hospital consumption 
amounted to $1,209. The more vigorous females were assigned to 
tasks in the laundry, sewing room, or salvage department. As a 
result of these various undertakings, between 75 and 80 percent of the 
patients are engaged in some form of work. All of the hospital 
laundering, with the exception of some bed sheets and pillowcases, 
and all of the nurses' uniforms, was done by the patients. 



31 

Farm. — Repairs to fences were made, and pastures cleared of brush 
during the dry season by cutting and burning pasture. There were 
24 cripples employed on the farm and hospital at the close of the year 
as compared with 22 at the beginning of the year. These men are 
employed in the garden, piggery, steam plant, cemetery, etc. Seven 
(including two chronic patients) are tending plots of land in the farm 
reservation, which they cultivate as gardens and ±hey are paid on an 
actual production basis. 

PALO SECO LEPER COLONY 
Dr. Ezra Hurwitz, Superintendent 

There were 106 patients at the Leper Colony on January 1, 1933. 
Seven new cases were admitted, seven patients died during the year; 
none were paroled and none absconded. At the close of the year 106 
patients remained, 91 for the Republic of Panama and 15 for the Canal 
Zone. 

Of the 7 deaths of lepers, all were autopsied at the Board of Health 
laboratory and, in accordance with the preference of the Manual of 
Joint Causes of Death of the Bureau of the Census, the cause of 
death was recorded as leprosy in all cases; the contributing causes of 
death were as follows: One chronic glomerulonephritis; 1 amyloid 
disease of the kidneys; 1 abscess, lower lobe, left lung, ruptured into 
pleura; 1 pulmonary tuberculosis; tuberculosis of the vertebral column; 
1 peptic ulcer; perforated duodenum; peritonitis, acute, generalized; 
in 2 cases no lesions other than those of leprosy were found. 

Intramuscular administration of the iodized esters of Hydnocarpus 
wightiana was continued as the routine treatment. Injections were 
given twice weekly, and although attendance was not compulsory, all 
patients except six reported with regularity for treatment. 

In April the Municipal Division completed installation of the water 
line from Balboa to the colony. The well, which has been the 
principal source of water (highly mineralized), but had never given a 
sufficient supply during the dry season, has not been abandoned, but 
will be kept in condition for use in emergency. 

In June, electric equipment consisting of two ranges (replacing 
the unsatisfactory oil-burning ranges), one stock pot and one water 
heater were installed in the kitchen. 

In July a graded road with a light surface of crushed stone was 
opened between Thatcher Highway and Palo Seco; and the launch 
Palo Seco II which had been used for transportation until then was 
turned over to the Section of Surveys. The colony was provided 
with an ambulance, which is adequate for the present needs of the 
colony. 



32 

A number of patients were permitted to visit relatives in Panama 
City, always attended by an officer of the Panama Health office, and 
one patient, with the permission of the Panamanian authorities was 
permitted to visit her aged mother in Los Santos. 

It would be desirable to separate patients in their quarters according 
to the severity of infection. Under present conditions this is practi- 
cally impossible, as patients in the same approximate stage of in- 
fections are often temperamentally unfit to associate peacefully. In 
planning future building at the colony, arrangement should be made 
for each patient to be quartered in a separate room. 

With profits accruing out of the resale storeroom, the colony pur- 
chased a new projector for talking motion pictures. Three motion 
picture agencies in Panama (Metro-Goldwyn-Mayer, Paramount, 
and Radio-Keith-Orpheum) each furnish the colony with one show 
weekly, without charge. The excellent pictures shown have been a 
great source of pleasure and contentment to the patients. 

The Palo Seco band received as gifts a saxophone from Mr. Danner, 
of the American Mission to Lepers, and a clarinet from Dr. Barbour 
of Boston, Mass. Other donations received, were from Woman's 
Auxiliary of Gatun Union Church, $10; Cristobal Women's Club, $5; 
and gifts of clothing to each patient were given through Father 
Lawler of St. Mary's Church. 

The allowances made to the patients during the year was $1,896; 
$1,164.33 worth of farm produce was bought from 29 patients; 54 
patients were employed in the colony and earned $3,110.73. 

DIVISION OF SANITATION 

The end of the dry season of 1933 was notable for an apparently 
unusually large invasion of anopheline mosquitoes into the sanitated 
areas, the probable reasons for which have been discussed elsewhere in 
this report. The continued growth and spread of Chara and other 
aquatic plants in Gatun Lake contributed largely to the increase in 
the numbers of anophelines. 

In the Rio Grande hydraulic fill west of the Canal near Balboa, a 
large drainage channel made in the soft mud by dynamite lowered 
the surface of the waters somewhat, but this area cannot be brought 
under satisfactory control until the whole area of more than a square 
mile is filled to an elevation of several feet higher, or an additional 
spillway, with its sill at a considerably lower elevation, is built. The 
Rio Grande fill and spillway at first impounded a large lake of brackish 
water with no outlet at low stages, simulating quite nearly the large 
brackish swamps of the Atlantic side, and here, for the first time in 



33 

our experience, Anopheles tarsimaculatus was found breeding on the 
Pacific side of the Canal Zone. Adults were taken on the screens of 
nearby quarters and at Fort Clayton, two miles away. 

The large hydraulic fill in the Thatcher Highway area developed, as 
is customary in such fills, myriads of deep cracks during the dry season, 
and when the rains and run-off from the hills had filled these with 
water they became prolific in breeding of Anopheles albimanus and 
Aedes taeniorhynchus larvae. It was necessary on two occasions 
(November 20 and December 21) to dust this fill with paris green 
from an airplane.' A five percent mixture of paris green with pulver- 
ized clay was sufficient to destroy most of the Anopheles. 

It was not necessary to use the airplanes in dusting the swamps at 
Old Panama during the rainy season of 1933. Straightening of the 
channel of the Rio Matias Hernandez through the western part of the 
swamp improved the drainage of this part considerably and the fact 
that cattle were not pastured in it as much as usual gave the swamp 
vegetation a chance to grow and shade the area. Breeding occurred 
only in small patches and was controlled by hand blowers dusting 
with a one percent paris green mixture. 

The new golf club building in the Sabanas northeast of Panama 
City has proved very popular as an evening resort for its members and 
guests, therefore it was necessary to improve the drainage of this area 
to prevent mosquito breeding. The open streams were trained and 
paved with 14-inch wide hemicylindrical precast concrete sections, 
4,523 linear feet being so installed. At acute bends the banks of the 
streams were rip-rapped with large stones. Also, 903 feet of subsoil 
tile were installed there. The golf club furnished part of the material 
and the greater part of the labor for this undertaking. 

Experiments were begun with mechanical and animal traps to 
catch adult mosquitoes, but the work has not sufficiently progressed to 
report results as yet. 

Malaria surveys of employees of the Canal and contractors engaged 
in large Canal undertakings in unsanitated areas were continued 
throughout the year. All persons found carrying the plasmodia of 
malaria were treated in an effort to reduce the number of carriers and 
clinical cases. It is believed that the results have justified the effort 
and expense. 

The enlarged new open grate incinerator at Summit, for the destruc- 
tion of the garbage of Ancon, Balboa, and Panama City, was placed 
in operation in April 1933. While during the dry season, with brisk 
north winds, the garbage burns almost completely in 24 hours, it was 

■ A subsequent dusting was necessary on January 9, 1934. 
MR 39231 3 



34 

found that during the season of rains and variable winds it required, 
at times, nearly 72 hours for complete incineration. Therefore the 
incinerator was trebled in size over its first design, allowing grate 
capacity for 3 days collection in serial order on the grate. It disposes 
of about 300 cubic yards of mixed garbage and rubbish, including 
large dead animals, daily. Because of its location in the open coun- 
try 12 miles from Panama, the smoke causes little or no nuisance. 
The garbage is unloaded from a ramp near the city by motor dump 
trucks, into chain cradles in specially constructed steel railroad cars 
and hauled to the grate by rail. It is unloaded from the cars by a 
crawler type tractor drawing out the chain cradles and emptying them 
on the grate, 15 to 20 cubic yards at a pull. 

The grates of the incinerator are constructed of old railroad rails 
cut in half-lengths, and no trouble has been experienced from buckling 
of the rails as no fire or accumulation of ashes is permitted beneath the 
grates. Comparatively very little fuel is used to burn the garbage. 
The fires are started by small piles of scrap' wood, old railroad ties, 
and rubber tires laid at intervals on the grates before the garbage is 
placed upon it. Once started, the fires burn through the pile, with a 
single stoker on hand to keep pulling unburned garbage over into the 
burning piles. Wet manure from dairy and horse barns proved most 
difficult to burn, the principal feed here, even in city stables, being 
green grass brought in from the country. This difficulty was over- 
come by dumping all manure into the sea, over a high sea wall, where 
the tides effectually dispose of it without nuisance. 

Notwithstanding that the breeding of various species of flies ap- 
parently was under careful control at the garbage disposal dump in 
Panama City during the last three years of its operation, the change in 
method of disposal — discontinuance of disposal dump and removal of 
all garbage from the city and its incineration at Summit— has resulted 
in a still further reduction in number of flies in Panama, more particu- 
larly those species which breed in decaying animal matter. 

(See pages 18 to 21 for additional information on anti-malaria work.) 

REPORT OF THE HEALTH OFFICER— PANAMA 

Dr. Jessie L. Byrd, Health Officer 

Dairy farm inspections. — All dairy cattle are tested once a year for 
T.B. reactors; any reactors found are either slaughtered or isolated 
from the dairy herds. Three thousand one hundred fifty-two dairy 
cattle were tested for T.B. during 1933, the intradermal test being 
used, and 264 reacted positively to the test. Ninety-one of these 



35 

reactors were from two farms, the owners of which have never given 
this department any cooperation in the prompt handling or disposal 
of their reactors. The other 18 dairy farms are practically free from 
T.B. at present. All dairymen are improving their stock by the 
importation of pure-blooded Holstein, Guernsey or Jersey cattle, and 
by crossing them with the native stock. Most of the dairy farms now 
have dipping vats and their cattle are almost free from ticks. 

Milk inspection. — This work starts at the dairy farms, where the 
inspector makes frequent checks on the sanitation of equipment, 
methods of handling, technique of milking, etc. He collects samples 
at the dairy, at the pasteurization plant, in stores and from delivery 
trucks. All milk sold retail in Panama is pasteurized and bottled at 
one of 4 pasteurization plants. While the consumption of fresh milk 
in Panama City is increasing, and will, no doubt, continue to increase 
somewhat, it is my opinion that fresh milk will never become a national 
drink or food here to the extent that it is in other countries. The 
present supply (about 1,300 gallons per day) is more than adequate 
to supply the demand (about 5,500 bottles or 1,100 gallons). Only 
about five percent of the population can afford to purchase fresh 
milk and have iceboxes or refrigerators in which to keep it. Milk 
usually is sold in bottles containing one-fifth of a gallon. The present 
retail price is 15 cents a fifth-bottle (75 cents a gallon). Five years 
ago the the retail price was $1 a gallon. The fresh milk on sale in 
Panama City is considered grade "A" pasteurized milk. However, 
there are one or two dairy farms which could improve their product 
and they will no doubt do so when the new milk ordinance goes into 
efifect. It will allow us to grade raw as well as pasteurized milk, and 
in that way will prevent the mixture of good and poor grade milk as 
sometimes happens now. 

Public health. — There have been no epidemics during the year. The 
communicable disease rate remains about the same as last year, except 
for amebic dysentery which shows a great increase during the past 
seven months as shown by the following number of cases reported: 
June, 14 ; July, 1 1 ; August, 26 ; September, 23 ; October, 25 ; November, 
41 ; December, 58. 

The reason for this sudden increase in amebic dysentery is unknown, 
but is probably due to better reporting on the part of Santo Tomas 
Hospital physicians. The infection in more than two-thirds of these 
cases was definitely traced to places in the interior of Panama, where 
a majority of the patients resided. The deaths of residents of Panama 
from amebic dysentery have been as follows for the past five years: 
1929, 3; 1930, 1; 1931, 3; 1932, 2; 1933, 9. 



36 

Garbage collection and disposal, and street cleaning. — Garbage is 
collected nightly in Panama City, Ancon, Balboa, and Albrook Field, 
an area of three square miles, and a population of approximately 
91,500 people, with the following equipment and force: One sanitary 
inspector (American); 2 foremen; 30 laborers; 7 trucks of ^tonseach 
(one of which collects rubbish and manure during the day) which 
average a little more than 8 loads daily. 

The following shows the gross cost of garbage collection, and of dis- 
posal of garbage and rubbish from Panama City, Ancon, Balboa, 
Albrook Field, and Fort Amador, and of street cleaning in Panama City 
during the year. The tonnage shown is considered fairly accurate, 
and was arrived at by the actual measurement of the trucks with and 
without top-load. The six night trucks average three cubic yards each 
without built-up sides and without top-load, and five and one-half 
cubic yards each with built-up sides and top-load. These figures 
check almost exactly with the yardage of the garbage cars which is 
known to be 75 cubic yards each. Three cubic yards are figured as 
weighing one ton: 
Garbage and rubbish collection, Panama City: 

Collected by Health Department tons-. 29,445 

Cost of collection — 

Total $39,962.40 

Per ton ^ 1 .36 

Per capita (79,000 population) _' .51 

Garbage collection, Ancon, Balboa, Quarry Heights, Albrook Field: (Rubbish in these 
places not collected by Health Department): 

Collected by Health Department tons__ 6,293 

Cost of collection — 

Total $16,350.41 

Per ton , 2.60 

Percapita (10,700) 1.53 

Garbage disposal, Panama City, Ancon, Balboa, Quarry Heights, Albrook Field, Fort 
. A mador : 

Collected by Health Department tons_. 32,983 

Delivered to railroad garbage cars by others tons. - 3,032 

Total garbage disposed of tons.. 36,015 

Cost of disposal — 

Total $25,236.72 

Per ton .70 

#er capita (91,500 population) .28 

Rubbish disposal, Panama City, Ancon, Balboa: 

Manure dumped over sea wall (October to December) tons.. 155 

Delivered at dump by Health Department tons.. 2,600 

Delivered at dump by others tons.. 12,000 

Total tons-- 14,755 



,37 

Rubbish disposal, Panama City, Ancon, Balboa — continued: 

Cost of disposal (salary of one man and maintenance of road) — 

Total $988.00 

Per ton .07 

Per capita (88,700 population) .01 

STREET CLEANING — PANAMA 

Total cost of street cleaning $22,771.63 

Cost of street cleaning per capita (79,000) . .29 

In April 1933, the enlarged open-grate incinerator at Summit was 
put into operation, and since then all garbage from the Pacific terminus 
has been disposed of there; also, all manure from the city of Panama 
was disposed of there from April until October 1933, since which time 
it has been dumped over the sea wall on the edge of Panama City, 
without creating a nuisance. 

The low cost of collecting garbage is due to the system in effect, 
which may be described briefly, as follows: The laborers are divided 
into what is known here as "pullers or placers," loaders and replacers. 
The puller precedes the tfucks by about two hours in residential 
districts and collects the garbage from each household can, placing it 
into a large galvanized tub; when the tub is full he empties it into a 
regulation garbage can and places the full can alongside the street. 
The truck has a driver and three loaders; two of the loaders ride on the 
running board of the truck and when the truck stops for a can there 
is no delay; the can is passed quickly to the loader on the truck who 
empties it and passes it back, all in one motion. In the business and 
tenement sections the pullers precede the trucks only about 30 minutes 
to one hour so that cans will not remain on sidewalks to be upset by 
mischievous boys and by dogs. This method permits rapid loading and 
reduces truck hours to the minimum. The average round-trip time 
per truck in the residential districts of Ancon and Balboa is about 60 
minutes; this time is reduced to 50 minutes in Panama City where the 
density of population is much greater. 

REPORT OF THE HEALTH OFFICER— CRISTOBAL-COLON 
Dr. Jesse C. Ellington, Health Officer 

General.— There were no epidemics during the year and the com- 
municable disease report compares favorably with reports for previous 
years. The general death rate of 16.27 is only slightly higher than the 
five-year average. The infant mortality rate of 114.96 is much higher 
than the rate for 1932, but only slightly higher than the average for 
the five years 1927-1931. The infant mortality rate and the tuber- 
culosis death rate of 3.5 no doubt' reflect the poor economic conditions 
prevailing in Colon throughout the year. 



38 

Mt. Hope cemetery. — One thousand forty (1,040) square yards of 
new road were constructed in the cemetery during the year by Munic- 
ipal Engineering Division forces, which greatly facilitates the han- 
dling of funeral processions. There were 493 burials, the receipts 
amounting to $3,413. Miscellaneous receipts amounted to $272.75. 

Street cleaning, garbage collection and disposal. — No changes were 
made in the methods of handling this work and the results were 
entirely satisfactory. Burning and burying of garbage and rubbish 
at the dump was carried out without fly breeding or other sanitary 
nuisances. 

Garbage and rubbish collection, Colon: 

Collected by Health Department tons.- 17,916 

Cost of collection — 

Total $26,030.20 

Per ton 1.46 

Per capita (30,000 population) .87 

Garbage collection, Cristobal and Mount Hope: 

Collected by Health Department tons.. 3,014 

Cost of collection — 

Total $5,570.34 

Per ton 1.84 

Per capita (6,247 population) .89 

Garbage disposal, Colon, Cristobal, Mount Hope, France Field: 

Delivered by Health Department tons-- 18,107 

Delivered by others tons-- 254 

Total tons-- 18,361 

Cost of disposal — 

Total $11,557.84 

Per ton .63 

Per capita (37,047 population) .31 

Rubbish disposal. Colon, Cristobal, and Mount Hope: 

Delivered by Health Department tons.. 2,823 

Delivered by others tons-- 3,805 

Total tons-. 6,628 

Cost of disposal — 

Total $650.00 

Per ton .10 

Per capita (36,247 population) .02 

Street cleaning. Colon (not including New Cristobal) : 

Total cost - $14,611.06 

Cost of street cleaning per capita (28,000 population) .52 



39 

Free clinic — Following is report of cases treated and other work 
done during the year: 

Eye, ear, nose and throat (clinic visits) 506 

Prenatal and postnatal (clinic visits) 1,897 

Babies (clinic visits) 2,230 

Dental (referred to Dr. Doten) 20 

Formulae prepared 8,741 

Medical and surgical (clinic visits) 131 

Referred to hospitals 125 

Other work by district nurse : 

Home visits ^ . 2, 973 

Vaccinations 3, 109 

Specimens to laboratory 454 

Mosquito and rat work. — Very few mosquito complaints were regis- 
tered during the year, except during seasonal flights from points out- 
side the city. Daily catches were made as an index. 

Rat catching to serve as an index was also carried out throughout 
the year and 4,704 traps were set, 1,152 rats caught, and 386 rats sent 
to the laboratory for examination. 

Inspection of food establishments. — Two hundred and three permits 
were issued to restaurants, hotels, dairies, milk plants, bottling plants, 
soft drink places, etc., and 48 permits were subsequently canceled due 
to establishments going out of business. Inspections were made as 
follows: Bakeries, 666; dairies, 196; milk plants, 421; bottling plants, 
355; markets, 1,466; ice cream plants, 357; restaurants, 2,233; 
soft drink places, 2,119. Samples of soft drinks, milk, ice cream, 
caustic solutions and foodstuffs to the number of 592 were sent to the 
laboratory. 

Dairies were maintained in good condition and 1,979 cattle were 
tested for tuberculosis. Five reactors were slaughtered. 

Animal quarantine inspections. — Inspections were made as follows: 
Cattle, 186; mules, 120; horses, 58; dogs, 18; monkeys, 15; guinea 
pigs, 10; circus animals, 10; miscellaneous, 21. 

REPORT OF THE DIVISION OF QUARANTINE AND 
IMMIGRATION 

Dr. Charles V. Akin, Surgeon, U.S.P.H.S., Chief Quarantine Officer 

The activities of the division show an increase over the year 1932, 
most of the increase taking place during the closing months of the year. 

No significant changes in quarantine procedure took place, but the 
closing month of 1933 saw a general tightening up in immigration 
requirements. Every effort will be made in the future to restrict 



40 



admissions to the Canal Zone and to the Republic of Panama to only 
such persons as give every guarantee that they will not become public 
charges. 

In addition to the duties incident to quarantine and immigration 
procedure the Chief Quarantine Officer is assisting in revising the 
sanitary code for the cities of Panama and Colon and in promoting 
personal hygiene activities among the civilian employees of the Canal, 
with particular reference to school groups. 

The Chief Quarantine Officer also acts for the United States Public 
Health Service as medical officer in charge of medical relief for 
merchant seamen and other beneficiaries of the service. 

The following table summarizes the activities for the year: 



Cristobal 



Total 



Vessels boarded and passed 

Vessels granted pratique by radio. 

Total 



Crew passed for quarantine 

Passengers passed for quarantine. 



Total 

Airplanes inspected and passed. 



Crew of airplanes inspected and passed 

Passengers of airplanes inspected and passed . 



Total 

Vessels detained in quarantine 

Crew and passengers detained aboard ship for quarantine. 

Persons admitted to station on account immigration laws. 

Number of detention days for the year 

Persons held for investigation and released 

Persons deported under immigration laws 

Supplementary sanitary inspection of vessels 

Vessels fumigated 

Box cars fumigated 

Deratization exemption inspections 

Revenues 

Subsistence 

Night boarding of vessels 

Fumigation of vessels 

Fumigation of box cars 

Deratization exemption inspections 



Rations issued 

Rats recovered after fumigation of vessels . 



2,426 
36 



3.222 
42 



5,648 
78 



2,462 



3,264 



5,726 



123,571 
37,077 



229,006 
86,905 



352,577 
123,982 



160,648 



315,911 



476,559 



30 



462 



492 



1.470 
1,861 



1.531 
1.929 



3,331 



3,460 



735 



735 



438 



42 
490 



985 



50 

928 



$8,849.45 

2,550.00 

890.50 

106.21 

120.00 



2,740 

26 

34 

4 



3,850.00 

1,205.10 

46.25 

50.00 



3.485 

39 

125 

10 

$8,849 45 

6,400.00 

2,095.60 

152.46 

170 00 



10,978 



10,978 



121 



REPORT OF THE DISTRICT NURSE FOR THE 
PACIFIC DISTRICT 

Number of baby clinics maintained 

Average number of babies enrolled per month 

Average number of babies visiting clinics per month 



6 
578 
239 



41 

Total number of visits to clinics 4,553 

Number of visits to cases of tuberculosis 56 

Total number of house visits 960 

Red Cross home hygiene classes were continued weekly at La 
Boca and Red Tank until the course was finished. At La Boca, 15 
girls took the final test on April 27, and 14 received certificates from 
Washington on June 24. At Red Tank, 11 girls took the final test 
on June 30, and 7 received certificates on August 18 from Washington. 

The district nurse assisted with the examination of school children 
on the Pacific side, and with the tuberculin tests which were started 
late in the year and are still underway. 

In December the baby clinic at Ancon was temporarily discontinued 
and a baby clinic started at the Panama Health Oftice, Panama City, 
at the request of the mothers in Panama who had been coming to 
Ancon. 



GENERAL TABLES 



Table l.-DISCHARGES FROM HOSPITALS, DEATHS, AND NONEFFECTIVE RATES 

FOR EMPLOYEES 

ABSOLUTE NUMBERS 





M 

D ^ 


Discharges from and 
deaths in hospitals 


Total deaths 


"It C3 






1 


i 

.3 

Q 


1 
g 

a 

1 


3 
^ 


•1 


3 

"3 
1 


" S. 

a cs 

C9 t,T3 


Year 1933: 

White 


3,244 
9,100 


1,153 
1,873 


1,070 
1,593 


83 
280 


16 
91 


15 

82 


1 
9 


23,072 
55,026 


63.21 


Black 


150.76 






Total 


12,344 


3,026 


2,663 


363 


107 


97 


10 


78,098 


213.97 






Year 1932: 

White 


3,387 
9,234 


1,113 
1,821 


1,050 
1,583 


63 
238 


17 
96 


15 

87 


2 
9 


21,151 
57,666 


57.79 


Black . 


157 56 






Total 


12,621 


2,934 


2,633 


301 


113 


102 


11 


78,817 


215,35 



ANNUAL KATE PER 1,000 EMPLOYEES 



Year 1933: 

White 




355.43 
205.93 


329.84 
175.16 


25.59 
30.77 


4.93 
10.00 


4.62 
9.01 


.31 
.99 




19.49 


Black 




16.57 








Total 




245.14 


215.73 


29.41 


8.67 


7.86 


.81 




17.33 








Year 1932: 

White 




328.61 
197.21 


310.01 
171.43 


18.60 
25.77 


5,02 
10.40 


4.43 
9.42 


.59 
.98 




17,06 


Black 




17.06 








Total 




232 47 


208.62 


23 85 


8.95 


8,08 


.87 




17.06 









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46 



Table 3.— DEATHS AND DEATH RATES OF RESIDENTS OF THE CANAL ZONE AND THE CITIES OF 

PANAMA AND COLON 



Place 


Popula- 
tion 


Deaths 


Annual rate per 1,000 
population 




Total 


Disease 


External 
causes 


Total 


Disease 


External 
causes 


Year 1933: 

Panama 


79.000 
30,000 
42,851 


1,181 

488 
305 


1,130 
469 
271 


51 
19 
34 


14.95 
16.27 
7.12 


14.30 
15.63 
6.32 


.64 
.63 




.80 






Total 


151,851 


1,974 


1,870 


104 


13.00 


12.31 


.69 


Year 1932: 

Panama 


77,500 
30,000 
42,070 


1,232 
433 
307 


1,171 
405 
272 


61 

28 
35 


15.90 
14.43 
7.30 


15.11 
13.50 
6.47 


.79 
.93 


Canal Zone 


.83 






Total 


149,570 


1,972 


1,848 


124 


13.18 


12.35 


.83 



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Table 6.-STATISTICS REGARDING AMERICAN EMPLOYEES AND THEIR FAMILIES. 1933 



Annual 
death rate 
per 1,000 



White employees from the United States: 

Disease 

External causes 

Total 

Families of white employees from the United States: 

Disease 

External causes 

Total 



White employees from the United States and their families: 

Disease 

External causes 



.35 


4.25 


•4.45 
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4.81 


4.27 
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Total . 



4.62 



Number of American children born on the Isthmus during the year 198 

Deaths among American children under 1 year of age 7 

Infant mortality rate among American children (number of deaths per 1,000 live births) 35 .35 



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83 



T.1BLE 9. 



-NUMBER OF DAYS HOSPITAL TREATMENT FURNISHED AND AVERAGE NUMBER IN 
HOSPITAL EACH DAY OF THE VARIOUS CLASSES OF PATIENTS, 1933 



Class of patients 


Number of days treatment 


Average number in 


hospital each day 


Ameri- 
can 


Foreign 


Black 


Total 


Ameri- 
can 


Foreign 


Black 


Total 


Gorgas Hospital: 


8,090 
48,690 

1,539 
4 

5,248 
11,895 


3,423 


19,603 


31,116 
48,690 
1,539 
65 
13,811 
54,071 


22.16 
133.40 
4.22 
.01 
14.38 
32.59 


9.38 


53.71 


85.25 




133.40 












4.22 


Panamanian Government 

Charity 


5 
2,306 
10,436 


56 

6,257 

31,740 


.01 

6.32 

28.59 


.15 
17.14 
86.96 


,18 
37,84 




148.14 






Total 


75,466 


16,170 


57,656 


149,292 


206.76 


44.30 


157.96 


409.02 






Corozal Hospital: 


226 

3,059 

6 


197 


9,355 


9,778 

3,059 

6 

107,404 

14,200 

37,966 


.62 

8.38 

.01 

'"i'.85' 
5.85 


.54 


25.63 


26.79 




8.38 












01 




17,077 
4,190 
6,591 


90,327 
9,335 
29,239 


46.79 
11.48 
18.06 


247.47 
25.58 
80.11 


294.26 


Charity 


675 
2,136 


38.90 


All others 


104.02 






Total 


6,102 


28,055 
1,095 
1,836 


138,256 

7,118 

23,647 


172,413 

8,213 

25,483 


16.72 


76.86 
3.00 
5.03 


378.78 
19.50 
64.79 


472.36 




22.50 


Chronics, medical and surgical cases . . 




69.82 


Colon Hospital: 


864 
8,197 

738 
3,101 


25 


3,834 


4,723 
8,197 
3,467 
14,991 


2,37 

22.46 

2.02 

8.50 


.07 


10.50 


12.94 




22.46 




288 
1,751 


2,441 
10,139 


.79 
4.80 


6.69 

27.78 


9.50 




41.07 






Total 


12,900 


2,064 


16,414 


31,378 


35.34 


5.65 


44.97 


85.97 






Palo Seco Leper Colony: 




1,460 
182 


26,757 
6,023 


28,217 
6,205 




4.00 
.50 


73.31 
16,50 


77.31 


Canal Zone Government 




17.00 








Total 




1,642 


32,780 


34,422 




4.50 


89.81 


94 31 








Total by classes: 


9,180 

59,946 

1,545 

4 

6,661 
17,132 


3,645 


32,792 


45,617 

59,946 

1,545 

135,686 

71,379 
107,028 


25.15 

164.24 

4.23 

18.25 
46.94 


9.99 


89.84 


124.98 




164.24 












4.23 


Panamanian Government 

Canal Zone Government, charity, 
cripples and chronics 


18,542 

9,897 

18,778 


117,140 

54,821 
71,118 


50.80 

27.12 
51.45 


320.93 

150.19 
194.84 


371.74 

195.56 
293.23 








94,468 


50,862 275,871 


421,201 


258.82 


139.35 


755.81 


1,153.97 







Table 10.— CONSOLIDATED REPORT OF ADMISSION, HOSPITALS AND DISPENSARIES, 1933 



All classes of patients 


White 


Black 


Total 


Admissions to hospitals, excluding Corozal farm (cripples and chronic ward) 


9,189 
3,646 


6,855 
3,882 


16,044 

7,528 








12,835 


10,737 


23,572 






Less number of patients transferred between hospitals and from quarters to hos- 


250 


338 


588 








12,585 


10,399 


22,984 






Employees only 
Employees admitted to hospitals 


1,171 
3,646 


1,960 
3,882 


3,131 




7,528 






Total aHmis,sinns nf emplnyefis 


.4,817 


5,842 


10,659 






Less number transferred between hospitals and from quarters to hospitals, whose 


55 


174 


229 








4,762 


5,668 


10,430 






Annual admission rate per 1,000 employees to hospitals and quarters 


1 1,467.94 


622.86 


844.94 



84 

Table II.— REPORT OF DISPENS.^RIES, 1933 

EMPLOYEES TREATED IN QUARTERS 



Dispensary 


Remaining 

January 1, 

1933 


Admitted 


Died 


Discharged 


Transferred 


Remaining 
December 
31, 1933 




White 


Black 


White 


Black 


White 


Black 


White 


Black 


White 


Black 


White 


Black 




1 

'5 


13 
3 


764 
1,516 

342 
■ 139 

874 
11 


1,193 
^71 
450 
226 

1,124 
118 






735 
1,519 
342 
135 
881 
11 


1,140 
774 
446 
218 

1,130 
111 


29 


62 


1 

2 


4 


^ Balboa 














...... 


3 

7 


1 




1 
S 


"26 

1 






1 








20 










8 
















Total 


15 


43 


3,646 


3,882 






3,623 


3,819 


34 


80 


4 


26 



















Dispensary furnishing treatment 

9 


Days treatment furnished 


Average number treated 
in quarters per day 


White 


Black 


Total 


White 


Black 


Total 




1,851 

4,927i 

983^ 

275 i 

3,140i 

16 


5,930 
4,715i 
l,677i 
l,050i 
10,025^ 
427 


7,781 
9,643 
2,661 
1,326 
13,166 
443 


5.07 
13.50 
2.69 

.75 
8.60 

.04 


16.25 
12.92 
4.60 

2.88 

27.47 

1.17 


21.32 


Balboa 


26.42 




7.29 




3.63 




36.07 




1.21 






Total 


11,194 


23,826 


35,020 


30.67 


65.28 


95 95 







ALL CASES TREATED 





Employees 


Nonemployees 


Total 


Dispensary 


White 


Black 


Total 


White 


Black 


Total 


White 


Black 


Total 


Ancon 


7,222 
11,493 
3,826 
3,098 
5,812 
■3,949 


17,204 
15,044 

7,898 
6,786 
14,789 
'6,926 


24,426 
26,537 
11,724 
9,884 
20,601 
10,875 


7,217 
16,089 
6,509 
4,040 
13,258 
Jl,208 


16,138 
13,575 
15,999 
8,221 
19,439 
'2,509 


23,355 

29,664 
22,508 
12,261 
32,697 
3,717 


14,439 
27,582 
10,335 

7,138 
19,070 

5,157 


33,342 

28,619 
23,897 
15,007 
34,228 
9,471 


47,781 
56,201 




34,232 


Gatun 

Colon 


22,145 
53,298 
14,628 






Total 


35,400 


68,647 


104,047 


48,321 


75,881 


124,202 


83,721 


144,564 


228,285 



' Includes 3,330 contractors' employees. ' Includes 4,897 contractors' employees. > Includes 1,043 members of 
families of contractors' employees. ■» Includes 2,093 members of families of contractors' employees. 

T.4BLE 12.— AVER.AGE NUMBER OF DAYS IN HOSPIT.AL AND QUARTERS FOR EACH ADMISSION, 

EMPLOYEES ONLY, 1933 





White 


Black 


Total 


Hospitals: 


10.83 
6.59 


18.93 
9.13 


15.59 




8.51 








10.33 


16.72 


14.28 






Quarters: 


2.52 
3.25 

2.88 
2.06 
3.59 
1.45 


5.24 
6.12 
3.75 
4.80 
8.92 
3,88 


4.17 




4.22 




3.37 




3.76 




6.59 




3.66 








3.10 


6.27 


4.72 







o 



MR 39231— Panama Canal— 8-21-34— 1,000